Intra-articular fragments
Updates to Article Attributes
Intra-articular fragments are a form of intra-articular bodies that result from traumatic injuries such as fractures, dislocations and chondral injury.
Clinical presentation
Symptoms are variable and also depend on the underlying cause and extent of the injury, but usual complaints are pain, limited motion, clicking, locking, snapping, and/or swelling.
Pathology
Intra-articular fracture fragments consist of bone, cartilage and bone, or pure cartilage depending on the extent and aetiology of the injury.
If intra-articular chondral or osteochondral fragments are not identified and removed, they can progress to post-traumatic osteoarthritis 1.
Aetiology
Typical aetiologies of intra-articular fracture fragments:
- articular fractures especially if multifragmentary or even comminuted
- dislocations and fracture-dislocations
- osteochondral fractures
- chondral fractures
Radiographic Features
Osseous fragments are usually radiodense structures with sharp edges located within the joint space.
Plain radiograph
They are on many occasions difficult to detect on plain radiography due to the superposition of other bony structures 1,2.
CT
Osseous or osteochondral fragments are easily detected on CT scans, which should be performed before and after surgery in case of fracture-dislocations or complex and/or comminuted articular fractures 1,2. Pure chondral fragments, however, are not easily detectable on conventional CT.
MRI
Osseous or osteochondral fragments show thin sclerotic edges and may have parts of trabecular bone. Pure chondral fragments are of intermediate signal intensity in T1 and proton density-weighted images and are hypointense in T2 and fat-saturated proton density-weighted images. They are best detected on normal non-fat saturated proton density or T2-weighted images due to the improved contrast versus synovial fluid 3.
Treatment and prognosis
Intra-articular fracture fragments are usually treated operatively or arthroscopically 1,2 4-7 and need to be removed or adapted if they are suitable for rescue and technical fixation 4,7. Otherwise, they can cause chondral damage and eventually leading to early osteoarthritis 2.
See also
-<p><strong>Intra-articular fragments </strong>are a form of <a href="/articles/intra-articular-loose-bodies-2">intra-articular bodies</a> that result from <a title="Traumatic injuries" href="/articles/trauma">traumatic injuries</a> such as <a href="/articles/fracture-1">fractures</a>, dislocations and <a title="Chondral injury" href="/articles/cartilage-injury-overview">chondral injury</a>.</p><h4>Clinical presentation</h4><p>Symptoms are variable and also depend on the underlying cause and extent of the injury, but usual complaints are pain, limited motion, clicking, locking, snapping, and/or swelling.</p><h4>Pathology</h4><p>Intra-articular fracture fragments consist of bone, cartilage and bone, or pure cartilage depending on the extent and aetiology of the injury. </p><p>If intra-articular chondral or osteochondral fragments are not identified and removed, they can progress to <a href="/articles/post-traumatic-osteoarthritis">post-traumatic osteoarthritis</a> <sup>1</sup>.</p><h5>Aetiology</h5><p>Typical aetiologies of intra-articular fracture fragments: </p><ul>- +<p><strong>Intra-articular fragments </strong>are a form of <a href="/articles/intra-articular-loose-bodies-2">intra-articular bodies</a> that result from <a href="/articles/trauma">traumatic injuries</a> such as <a href="/articles/fracture-1">fractures</a>, dislocations and <a href="/articles/cartilage-injury-overview">chondral injury</a>.</p><h4>Clinical presentation</h4><p>Symptoms are variable and also depend on the underlying cause and extent of the injury, but usual complaints are pain, limited motion, clicking, locking, snapping, and/or swelling.</p><h4>Pathology</h4><p>Intra-articular fracture fragments consist of bone, cartilage and bone, or pure cartilage depending on the extent and aetiology of the injury. </p><p>If intra-articular chondral or osteochondral fragments are not identified and removed, they can progress to <a href="/articles/post-traumatic-osteoarthritis">post-traumatic osteoarthritis</a> <sup>1</sup>.</p><h5>Aetiology</h5><p>Typical aetiologies of intra-articular fracture fragments: </p><ul>
References changed:
- 1. Pedersen M, DaCambra M, Jibri Z, Dhillon S, Jen H, Jomha N. Acute Osteochondral Fractures in the Lower Extremities - Approach to Identification and Treatment. TOORTHJ. 2015;9(1):463-74. <a href="https://doi.org/10.2174/1874325001509010463">doi:10.2174/1874325001509010463</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/26587063">Pubmed</a>
- 2. Pascarella R, Maresca A, Reggiani L, Boriani S. Intra-Articular Fragments in Acetabular Fracture–Dislocation. Orthopedics. 2009;32(6):402. <a href="https://doi.org/10.3928/01477447-20090511-15">doi:10.3928/01477447-20090511-15</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/19634828">Pubmed</a>
- 3. Rodrigues M & Camanho G. MRI Evaluation of Knee Cartilage. Rev Bras Ortop. 2010;45(4):340-6. <a href="https://doi.org/10.1016/S2255-4971(15)30379-7">doi:10.1016/S2255-4971(15)30379-7</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/27022562">Pubmed</a>
- 4. Farr J, Covell D, Lattermann C. Cartilage Lesions in Patellofemoral Dislocations. Sports Med Arthrosc. 2012;20(3):181-6. <a href="https://doi.org/10.1097/jsa.0b013e318259bc40">doi:10.1097/jsa.0b013e318259bc40</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/22878659">Pubmed</a>
- 5. Rungprai C, Tennant J, Gentry R, Phisitkul P. Management of Osteochondral Lesions of the Talar Dome. TOORTHJ. 2017;11(1):743-61. <a href="https://doi.org/10.2174/1874325001711010743">doi:10.2174/1874325001711010743</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/28979588">Pubmed</a>
- 6. Lording T, Lustig S, Servien E, Neyret P. Chondral Injury in Patellofemoral Instability. Cartilage. 2014;5(3):136-44. <a href="https://doi.org/10.1177/1947603514530142">doi:10.1177/1947603514530142</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/26069693">Pubmed</a>
- 7. Siparsky P, Bailey J, Dale K, Klement M, Taylor D. Open Reduction Internal Fixation of Isolated Chondral Fragments Without Osseous Attachment in the Knee. Orthopaedic Journal of Sports Medicine. 2017;5(3):232596711769628. <a href="https://doi.org/10.1177/2325967117696281">doi:10.1177/2325967117696281</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/28451604">Pubmed</a>
- 1.Pedersen ME, DaCambra MP, Jibri Z, Dhillon S, Jen H, Jomha NM. Acute Osteochondral Fractures in the Lower Extremities - Approach to Identification and Treatment. (2015) The open orthopaedics journal. 9: 463-74. <a href="https://doi.org/10.2174/1874325001509010463">doi:10.2174/1874325001509010463</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/26587063">Pubmed</a> <span class="ref_v4"></span>
- 2.Pascarella R, Maresca A, Reggiani LM, Boriani S. Intra-articular fragments in acetabular fracture-dislocation. (2009) Orthopedics. 32 (6): 402. <a href="https://doi.org/10.3928/01477447-20090511-15">doi:10.3928/01477447-20090511-15</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/19634828">Pubmed</a> <span class="ref_v4"></span>
- 3.Rodrigues MB, Camanho GL. MRI EVALUATION OF KNEE CARTILAGE. (2010) Revista brasileira de ortopedia. 45 (4): 340-6. <a href="https://doi.org/10.1016/S2255-4971(15)30379-7">doi:10.1016/S2255-4971(15)30379-7</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/27022562">Pubmed</a> <span class="ref_v4"></span>
- 4.Farr J, Covell DJ, Lattermann C. Cartilage lesions in patellofemoral dislocations: incidents/locations/when to treat. (2012) Sports medicine and arthroscopy review. 20 (3): 181-6. <a href="https://doi.org/10.1097/JSA.0b013e318259bc40">doi:10.1097/JSA.0b013e318259bc40</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/22878659">Pubmed</a> <span class="ref_v4"></span>
- 5.Rungprai C, Tennant JN, Gentry RD, Phisitkul P. Management of Osteochondral Lesions of the Talar Dome. (2017) The open orthopaedics journal. 11: 743-761. <a href="https://doi.org/10.2174/1874325001711010743">doi:10.2174/1874325001711010743</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/28979588">Pubmed</a> <span class="ref_v4"></span>
- 6. Lording T, Lustig S, Servien E, Neyret P. Chondral Injury in Patellofemoral Instability. (2014) Cartilage. 5 (3): 136-44. <a href="https://doi.org/10.1177/1947603514530142">doi:10.1177/1947603514530142</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/26069693">Pubmed</a> <span class="ref_v4"></span>
- 7.Siparsky PN, Bailey JR, Dale KM, Klement MR, Taylor DC. Open Reduction Internal Fixation of Isolated Chondral Fragments Without Osseous Attachment in the Knee: A Case Series. (2017) Orthopaedic journal of sports medicine. 5 (3): 2325967117696281. <a href="https://doi.org/10.1177/2325967117696281">doi:10.1177/2325967117696281</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/28451604">Pubmed</a> <span class="ref_v4"></span>